Comorbidities Frequent in Gout Patients

Patients with gout had at least one comorbidity, according to new study.

Comorbidities are common in patients with gout at diagnosis and are even likelier following the diagnosis, according to a case control study by authors from the U.K. and Taiwan.

"This study suggests that a thorough search for a broad range of comorbidity and subsequent vigilant observation should be considered for all patients with gout from the date of first diagnosis," they wrote in Annals of the Rheumatic Diseases.

The case control study was conducted within the Clinical Practice Research Data-link, a U.K. database containing medical records of about 12 million individuals. From this database, 39,111 patients (72.5% men; mean age, 62.2 years) with incident gout were identified. Controls were matched individuals without gout identified at random from the same database. Comorbidities were assessed 10 years prior to diagnosis, 1 year prior to diagnosis, and from diagnosis to the occurrence of a comorbidity, death, or end of the study. The cumulative probability of comorbidity was estimated at the time of diagnosis (index date) and at 1 year, 2 years, 5 years, and 10 years following diagnosis.

At the time of diagnosis, significantly more people with incident gout had at least one comorbidity in the Charlson index compared with controls (32.25% versus 27.95%; P<0.001). Retrospective observation showed that cardiovascular and genitourinary diseases were associated with a higher risk for incident gout. The highest risks were for renal diseases, with an odds ratio (OR) of 5.96 and congestive heart disease (OR 4.37). In adjusted models in the 10-year and 1-year periods prior to diagnosis, hyperlipidemia (OR 1.71), hypothyroidism (OR 1.50), anemia (OR 1.40), psoriasis (OR 1.32), chronic pulmonary diseases (OR 1.30), osteoarthritis (OR 1.27), and depression (OR 1.09) were positively associated with incident gout.

Development of a first comorbidity was significantly faster in patients with incident gout. The median time to a first comorbidity was 43 months (95% CI 41-45 months) in patients with incident gout and 111 months (95% CI 108-115 months) in controls (P<0.001). A first comorbidity occurred in 42.09% of the group with incident gout versus 30.78% of the controls at 1 year post index, 45.39% versus 33.32% at 2 years, 53.99% versus 40.92% at 5 years, and 66.28% versus 51.51% at 10 years.

The cumulative probability of any increase in the Charlson index after diagnosis was significantly greater in patients with gout than in controls at all time points after diagnosis (P<0.001).

Gout was associated with an adjusted hazard ratio (HR) of 1.41 (95% CI 1.34-1.48) for having a Charlson index ≥1. The risk of an incident cardiovascular, genitourinary, metabolic/endocrine, and musculoskeletal/connective tissue disease comorbidity was higher in patients with gout, including triple the risk of incident renal disease (HR 3.18, 95% CI 2.88-3.50). Risks of liver diseases, hemiplegia, depression, anemia, and psoriasis were also higher in patients with gout.

Mortality at 5 years and 10 years after the index date was significantly higher (P<0.001) in patients with gout compared with matched controls: 14.43% versus 11.14% at 5 years and 26.98% versus 21.66% at 10 years. After adjustment for potential confounders, gout was associated with a HR of 1.13 (95% CI 1.08-1.18) for all-cause mortality (P<0.001).

Because some of the comorbidities, such as hypothyroidism and anemia, found to be associated with gout are not included in gout patient management guidelines, "this study supports the case for a comprehensive investigation for comorbidities, including but not limited to 'checklists,' as an integral part of initial assessment for patients with gout at diagnosis," according to the authors.

Limitations include potential misclassification of gout and comorbidities. In addition, all potential risk factors for gouty arthritis are not recorded in the database and therefore could not be adjusted for.

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